work comp 101 presentation. the way it was……. here is the story…

WORK COMP 101

Presentation

What is Workers’ Compensation?

Provide income and medical benefits to injured employeesProvide a single, exclusive

remedyEncourage employer interest

in safety and promote accident investigations

The Way it Was…….Here is the story…..

Started in 1870 with organized laborEmployee had to sue to receive benefitsEmployee had to prove employer was at

faultIn 1915 case law was enacted to protect

the injured worker:• Resulting in the employee no longer having to sue for

qualified benefits• Benefits, when qualified, are paid according to the

new law

Benefits under Act 57Coverage begins on employees start

dateMedical coverage

Loss of wagesDeath Benefits

Restoration to pre-injury condition

Medical Benefits'Reasonable treatments from Panel

approved provider-first 90 daysPrescription coverageOut of pocket receipts for applicable

expensesSecond opinions on surgical cases may be

required and covered

$ Loss of Wages $1. You are not eligible for benefits until

after the 7 day grace period 2. Checks Calculate to 2/3 of

employees average weekly wage3. First check is issued within 21 days4. Partial disability benefits

Death & Dismemberment Death benefits are available to surviving

dependents Specific loss benefits are available for

amputations and disfigurement

Misconceptions of Workers Comp Coverage

Is not to be confused with:

I. WelfareII. Health InsuranceIII. UnemploymentIV. SSDV. Supplement

income plan

Does not pay time off to attend:

I. Physical TherapyII. Chiropractic visitsIII. Picking up

prescriptionsIV. Physician visits

Employer Responsibilities

Timely reporting of a claim to PComp from the County or C.R.E. thru RISKMASTER

Loss time status notification is important Providing guidance to injured employee’s with panel

provider assistance If the injured employee changes status notify PComp

of the change when information is discovered When requested for wage loss calculations, please

respond in a timely fashion to ensure employee’s are paid within the guidelines of the Workers Compensation Act

Notify PComp when an injured employee has returned to work; full or modified duty

Injured Workers Responsibility

1) Report your claim immediately to your supervisor or HR

2) If your not going to the ER, determine a panel approved physician(posted in your workplace) required 90 days min. treatment with panel provider

3) If referred by the ER Physician for follow up, seek an equivalent panel provider contact HR for updated list

4) Report your status and provide all medical documents to your supervisor or HR department on a frequent basis

5) Notify PComp of any changes

PComp’s Claims process

Claim is received by PComp from the County or C.R.E. thru RISKMASTER

The claim is investigated by an assigned adjuster Adjuster has 21 days to accept or deny the claim

after the notice is received Confirm the employee is treating with a panel

provider for the first 90 days For additional support a Nurse Case Manager may

be assigned when needed

Investigation process The first 48 hours-adjuster makes three

point contact Identify the injury and its relationship to the

accident description Collect key written statements from all

parties involved which can include recorded statements and witness interviews

If the claim is not accepted the adjuster will notify in writing and/or advising employee of their rights

Claim Discretion Employees information shared between

the supervisors and adjusters is private Family members of the employee are

not substitutes for direct communication and information should not be shared with them concerning the claim-HIPPA

Remember this is your claim!

Questions??

On-line claims reporting https://onlineclaims.pacounties.org PComp PO Box 60769

Harrisburg, PA 17106 Phone: (800) 895-9039

Fax: (888) 692-2368

CCAP Insurance Programs

Meet the Staff Claims Manager: Dave Harman Claim Adjusters: Marian Mark mmark@pacounties.org Donna Lyter dlyter@pacounties.org Jon Buehler jbuehler@pacounties.org Dianne Carman

dcarman@pacounties.org